What Epic & Cerner are doing for interoperability: 11 observations

Interoperability is one of the biggest healthcare issues to solve. Vendors and providers are tasked with using technology to freely, but securely, exchange information to create a continuum of care with greater value and less cost for the patient. That is no mean feat, considering the myriad moving parts and largely siloed nature of healthcare. Here are 11 points on how two of health IT's biggest vendors, Epic and Cerner, are throwing their hats into the interoperability ring and what the industry thinks of those efforts.

Cerner

1. Cerner's website offers the Interoperability Ticker, an interactive map that tracks clinical transactions, pharmacy transactions, health information exchanges and Cerner interoperability solutions in use across the country. The ticker also offers a live feed of current transactions.

2. Cerner is a founding member of the CommonWell Health Alliance, a nonprofit organization focused on developing and deploying interoperability solutions. The company offers its clients free access to CommonWell services, until January 2018. Services include patient identification and linking, record location and retrieval and patient access and consent management.

3. Cerner, along with Brightree and McKesson, will be the first CommonWell members to offer the organization's interoperability solutions for the post-acute care space.

4. Two Cerner executives are members of the KLAS & Interoperability Measurement advisory board, which held its inaugural meeting in February. John Glaser, PhD, Cerner's senior vice president of client administration, and Bob Robke, Cerner vice president of interoperability, sit on the board.

5. Cerner was one of 12 vendors that agreed to new interoperability metrics discussing during the KLAS Keystone Summit in 2015. Cerner president Zane Burke helped create the new metrics.

6. KLAS ranked the top 10 EHR vendors by interoperability in a 2015 report. Cerner ranked No. 3 with a score of 3.3. KLAS noted the vendor's strength lay in offering strong tools for building complex connections. On the other hand, clients reported irritation with costs and client-to-client sharing software.

Epic

6. Epic's Care Everywhere is designed to provide a framework for interoperability. The platform allows information flow from Epic EHRs and non-Epic EHR across state and national borders, according to the company's website. Click here to view a full list the organizations in the Care Everywhere network.

7. Care Everywhere participants exchange information with 26 EHRs from other vendors, 21 health information exchanges, 29 health information service providers and 28 eHealth Exchange members, as of July 2014, according to a HealthIT.gov Epic Interoperability Fact Sheet. More than 20 billion data transactions happen between Epic and more than 600 other vendors through more than 12,000 interfaces each year, according to the fact sheet.

8. In 2015, KLAS ranked Epic No. 1 for interoperability on a list of 10 EHR vendors. Epic earned a score of 3.8. The KLAS report pointed to Epic's savvy and respected interoperability team as a strength, but noted the company is perceived as inflexible and closed off.

10. Epic was also among the 12 health IT vendors to have a seat at the table when it came to creating new interoperability metrics at the KLAS Keystone Summit in 2015. CEO and founder Judy Faulkner had a hand in creating the new metrics.

11. Though Epic is involved in a number of public interoperability initiatives, the company has faced widespread criticism for its interoperability in action. The company's absence from the CommonWell Health Alliance has been widely noted, and Epic has had to publicly defend itself.

In March 2015, Mr. DeVault defended the company's interoperability capabilities and efforts at a U.S. Senate Committee on Health, Education, Labor and Pensions hearing focused on EHRs and meaningful use. "Epic does not own or claim rights to our customers' patient data. We do not interfere with their ability to access patient data and we do not re-sell patient data. We give our customers access to our source code and developer support. We also provide tools that support the free flow of information between different system [sic] and different organizations," Mr. DeVault said during the hearing.

One of the harshest critiques came from news organization Mother Jones. The October 2015 article called out the vendor for lack of interoperability and its focus on Epic-to-Epic data exchange. The article's author, Patrick Caldwell, did not stop at interoperability, but continued on to comment on Ms. Faulkner's politics and the actual function of Epic's systems — below average in his opinion.

The month after the article's release, Epic responded. Mr. DeVault wrote a letter defending his company's reputation and offered counterarguments to the Mother Jones barbs. "The story took on a difficult and important topic related to EHR systems and their ability to interoperate. Unfortunately, it was based on discredited and unsubstantiated claims against Epic," he said in the letter.

Is the sandbox big enough for Epic and Cerner?

Cerner and Epic have both declared themselves for the interoperability cause, but competition between the two companies is no secret. They continually vie for the biggest piece of the health IT market and mindshare, leading many in the industry to wonder if the two vendors can truly set aside rivalry to work together for a common good. In November 2015, leaders from Cerner and Epic were in the same room during the Disruptive Healthcare Conference held in Madison, Wis., according to a WTN News report.

Both Epic's Mr. DeVault and Cerner's Mr. Robke spoke on an interoperability panel at the conference. Mr. Robke noted the companies have mutual clients and their teams were able to work together. He also openly extended an invitation for Epic to join CommonWell.

Mr. DeVault did not accept the invitation, but did look to the future. "How can we make sure that CommonWell, which is one network among many, and Care Everywhere, which is one network among many, and all the different [participants] can communicate with each other?" he said. "Because that is the world we will always be living in. There is not a magical future down the road in which there is one health information exchange network called CommonWell or anything else."

Neither executive offered a ringing affirmation of future cooperation between the companies, but the willingness to do so was not outright cast aside. As the march toward interoperability continues, some in the industry don't even think major EHR vendors will remain relevant. Startups focused on interoperability are proliferating. The industry's legacy vendors could be supplanted by an up-and-comer in the game when it comes to solving the interoperability puzzle.

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